Lumbar spine
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Lumbar Spine. Todd McCall, M.D. Assistant Professor of Neurosurgery. Symptoms Back pain Degenerative disc disease Facet arthropathy Compression fracture Radiculopathy Herniated disc Synovial cyst. Radiographic findings Stenosis Spondylolisthesis. Introduction. Red flags.

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Lumbar Spine

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Lumbar Spine

Todd McCall, M.D.

Assistant Professor of Neurosurgery


Symptoms

Back pain

Degenerative disc disease

Facet arthropathy

Compression fracture

Radiculopathy

Herniated disc

Synovial cyst

Radiographic findings

Stenosis

Spondylolisthesis

Introduction

Red flags


Common causes

Myofascial

Hip arthritis

SI joint

Lumbar Spine

Degenerative disc disease

Facet arthropathy

Compression fx (osteoporosis)

Scoliosis

Less common causes

Metastasis

History of cancer

Unexplained weight loss

Discitis / Osteomyelitis

Recent infection or fever

Traumatic injury

Recent fall, etc

Back pain


Back Pain

  • Typically start with 4-8 week course of PT (unless red flag present)

    • Water therapy for unloading

      • Useful clinical information

    • Core strengthening

    • Traction, TENS, etc.

  • Meds: NSAIDs (avoid narcotics)

  • If fail initial treatments, then get imaging studies


Degenerative disc disease


Bone scan

  • text


Facet arthropathy


Increasing incidence with aging population

Pain worse with axial loading

Treatments:

Watch

Bracing

PT

Kyphoplasty

Important to treat underlying osteoporosis

Compression fx (osteoporotic)


Imaging studies

X-rays

Good for screening

CT

MRI

contrast

Bone scan

Compression fx (osteoporotic)


Radiculopathy

  • Due to nerve irritation or compression

  • Symptoms

    • Pain / tingling

    • Numbness

    • Weakness

      • L4/5: ADF, foot drop

      • L5/S1: APF


Radiculopathy: herniated disc

  • Treatment

    • Meds (steroid)

    • PT

    • ESI

    • Surgery


Cauda equina syndrome

  • Usually due to massive disc herniation

    • L4/5 most common level

    • Often underlying stenosis

  • Symptoms

    • Urinary retention (most sensitive)

    • Incontinence (overflow)

    • Saddle anesthesia (anus, genitals, perineum)

    • Weakness (often multiple myotomes)

    • Pain

SURGICAL EMERGENCY


Cauda equina syndrome

normal


Radiculopathy: synovial cyst


Stenosis

  • Due to:

    • Disc bulging

    • Lig. flavum hypertrophy

    • Facet arthropathy

    • Spondylolisthesis

    • Synovial cysts


Stenosis

  • Neurogenic claudication

    • Pain in legs worse with walking, alleviated with rest

    • Symptoms better with flexion (leaning over shopping cart)

      • Opens central canal

  • Treatment

    • PT (traction)

    • ESI

    • Surgical decompression


Symptoms

Back pain

Neurogenic claudication

central canal stenosis

Radiculopathy

lateral recess stenosis

neuroforaminal stenosis

Spondylolisthesis


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